Review : Ethics for health care (2nd edition) by Catherine Berglund

Ethics is a broad discipline and in health the debate between bioethics and behavioural ethics is one that goes to the centre of public health debates.

Evaluation of a training program to assist care staff to better recognize and manage depression among palliative care patients and their families

This study was designed to evaluate the effectiveness of a training program to improve the knowledge, attitudes, and self-efficacy of palliative care staff and thus enable them to better detect and manage depression among palliative care patients and their families. Participants were 90 professional carers who completed a four-session training program. Knowledge, attitudes, self-efficacy, and barriers to working with depressed patients were assessed preintervention, post-intervention, and at a three-month follow-up. The results demonstrated that compared to the control group, the intervention group had improved in all of these areas. Improvements were maintained at the three-month follow-up in all areas except attitudes. The results of this study indicate the importance of training in managing depression among palliative care staff. Booster sessions will likely be needed to ensure that training program gains are maintained.

‘Moral luck’ and the question of autonomy, choice, and control in end-of-life decision making

It is commonly assumed that, in the realm of ethical decision making at the end-of-life, ‘luck’ and ‘risk’ do not intrude. Nonetheless ‘moral luck’ (where happenstance makes a moral difference) does intrude and can have an unanticipated impact on the ultimate moral outcomes of end-of-life care. In the interests of upholding the ethical standards of end-of-life care, healthcare providers have increasingly relied on ethical principlism as a rational decision-guiding frame in the sincere belief that such an approach will enable patient selfdetermination and control over treatment decisions when needing end-of-life care. Due to contextual variables and associated uncertainties in end-of-life care, however, the intended moral outcomes of appeals to commonly accepted ethical principles (in particular the principle of autonomy) are not always realized. What is not always appreciated is that whether ‘good’ or ‘bad’ moral outcomes are achieved can be as much a matter of chance as of choice. This essay explores the relevance and possible implications of moral luck in end-of-life decision making and care. A key conclusion of the paper is that the notion of moral luck needs to be taken seriously in end-of-life care contexts since it can have an unanticipated impact on the outcomes of the decisions that are made and thereby on the moral interests of patients facing the end of their lives.

Critically impaired infants and end of life decision making : resource allocation and difficult decisions

Decisions to withdraw or withhold life-sustaining treatment are contentious, and offer difficult moral dilemmas to both medical practitioners and the judiciary. This issue is exacerbated when the patient is unable to exercise autonomy and is entirely dependent on the will of others.This book focuses on the legal and ethical complexities surrounding end of life decisions for critically impaired and extremely premature infants. Neera Bhatia explores decisions to withdraw or withhold life-sustaining treatment from critically impaired infants and addresses the controversial question, which lives are too expensive to treat? Bringing to bear such key issues as clinical guidance, public awareness, and resource allocation, the book provides a rational approach to end of life decision making, where decisions to withdraw or withhold treatment may trump other competing interests.The book will be of great interest and use to scholars and students of bioethics, medical law, and medical practitioners.

Algumas polêmicas envolvendo a utilização de células-tronco embrionárias no Brasil: um desafio à inovação jurisdicional

A finalidade da presente dissertação será o exame de algumas das muitas polêmicas éticas e jurídicas que envolvem a utilização das células-tronco embrionárias humanas para fins de pesquisa e terapia. A utilização de tais células-tronco foi aprovada pela Lei n.º 11.105 de 2005, conhecida como a nova Lei de Biossegurança, cujo artigo 5º permitiu, apenas para fins de pesquisa e terapia, a utilização das citadas células obtidas de embriões humanos provenientes do processo de fertilização in vitro, não utilizados no respectivo procedimento, atendidas certas condições. Assim que entrou em vigor, o citado dispositivo sofreu por parte do Procurador Geral da República a Ação Direta de Inconstitucionalidade (ADI) nº 3510, que gerou amplos debates de âmbito multidisciplinar. Apesar da declaração de constitucionalidade do referido artigo, ainda são muitas as polêmicas de ordem jurídica e ética. Questiona-se, principalmente, as divergências existentes acerca da natureza jurídica do embrião, produzido in vitro e excedente nos processos de fertilização, bem como a adequação do princípio constitucional da Dignidade Humana neste contexto. São demonstradas, ainda, questões pertinentes ao patenteamento de material genético e, consequentemente, das células-tronco embrionárias.